Nail changes in diabetes mellitus along with dermoscopic correlation: A cross-sectional observational study from a tertiary care institute in North India

Objectives: The pathological process of diabetes that occurs systemically is reflected in the nail, thereby helping in the early diagnosis and optimal management of diabetes. Hence, the aim of our study was to study the nail changes in patients with diabetes mellitus (DM) and compare these nail changes with those occurring in non-DM patients. Materials and Methods: This cross-sectional observational study enrolled 200 patients which included 100 cases of DM and 100 non-DM age- and sex-matched controls and was conducted in a tertiary care institute over a period of 1.5 years. Onychoscopy was performed on all the patients. Results: Onychomycosis was present in 29% of diabetics as compared to 11% of controls (statistically significant – P = 0.001). Ragged cuticle was present in 63% of diabetics as compared to 22% of controls ( P = 0.001). Longitudinal ridging was present in 46% of diabetics and 28% of controls ( P = 0.008). Pitting was present in 8% (statistically not significant; P = 0.2), onychodystrophy in 4% ( P = 0.04), paronychia in 16% ( P = 0.002), and distal onycholysis ( P = 0.05) of diabetics. Other nail changes included pterygium, leukonychia, Beau’s lines, thickening of the nail plate, melanonychia, and subungual hyperkeratosis. Conclusion: The nail changes are an important indicator of the underlying metabolic alterations. The nail changes that can be used as screening for DM include onychomycosis, paronychia, ragged cuticle, distal onycholysis, and onychodystrophy. Dermoscopy plays an important role in diagnosing these nail changes.